Understanding the nature and scale of the issues associated with doctors’ induction

What were the key findings?

  • Doctors’ experiences of inductions varied by setting, specialty and career stage. The majority of the doctors interviewed had experienced a number of inductions and could cite both good and bad practice. 
  • Doctors and associate/directors of medical education agreed there were key elements that needed to be included in inductions such as providing information at a ‘local’ level and in advance of starting, and offering as much tailored and hands-on induction as possible
  • Multiple drivers and barriers to good and safe induction were identified. These included the relative costs and benefits of inductions, such as staff time. But also broader factors such as doctors feelings unwilling or unable to complain about poor induction.
  • The impact of poor induction was often linked to the effect it has on doctors and their wellbeing. But there were also cases where it was linked directly to patient safety, eg doctors being unaware of emergency procedures/where vital equipment was.
  • Poor induction is also potentially a contributing factor to poor patient safety as doctors who feel ‘out of their depth’ are more likely to make mistakes. 

What did the research involve?

A rapid literature review of issues relating to doctors’ induction was followed by a series of qualitative telephone interviews across England, Scotland and Northern Ireland, which included:

  • 41 doctors who had recently started a new post or returned to work (in the last six months)
  • across primary and secondary care and at different career stages including:
    • doctors in training
    • locums
    • international medical graduates
    • doctors returning to practice (returners)
    • newly qualified consultants.
  • Nine stakeholders who were involved in delivering induction or had an interest in the induction of doctors. Including national bodies deaneries and individual trusts/health boards.

Please note 

All interviews were conducted between 23 September and 6 December 2019, so did not include doctors who had returned specifically due to COVID-19, or doctors that were practising in that context. 

Why did we commission this research?

Data and evidence we collect as part of our regular work suggested that there may be some issues with induction for doctors including variation, inappropriate timing, poor content or in some cases a lack of induction at all.

There was also anecdotal evidence of a lack of awareness of current resources for those returning to practice after a break. 

We commissioned research to better understand these issues and to investigate:

  • How common are issues with inductions for doctors?
  • What does a safe and effective induction for a doctor look like?
  • What factors are likely to be causing good and bad practice with regards to doctors’ inductions?
  • To what extent does bad practice in inductions affect doctors and therefore pose a risk to patient safety?

Full report

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